Geographic distribution of EmOC facilities

Theassessment by map or interactive geographic
information system (GIS) of the actual geographic distribution, distances, and
travel time to emergency obstetric care (EmOC) facilities. Optimally, basic
EmOC facilities should be located so they can be accessed within a maximum of two
hours, and comprehensive EmOC facilities should be accessible within a maximum
of 12 hours UNFPA (2004).

Basic EmOC service
facilities are defined by the performance of the complete set of these seven
signal functions (WHO et al., 2010):

The facility is
classified as functioning at the comprehensive EmOC level when it offers the
seven signal functions plus surgery (e.g. caesarean) and blood transfusion. For additional background on this indicator
and basic and comprehensive EmOC, see WHO et al, (2010); UNFPA (2004); and AMDD (2003).

This indicator is
calculated as:

The number and
distribution of basic EmOC service facilities, and/or estimates of the
proportion of the population within two hours travel time from a facility,
calculated using maps or a GIS mapping system for subnational areas, such as districts,
subdistricts, and urban areas.

Alternatively, the
minimum acceptable number of comprehensive EmOC facilities for an area can be estimated
by dividing the subnational area population by 500,000. The resulting number is
multiplied by five to calculate the overall minimum number basic and comprehensive
facilities for the area. To calculate the percentage of the recommended minimum
number of facilities that is available to the district population, divide the
number of functioning EmOC facilities by the recommended number and multiply by
100. To ensure equity and access, all of the district and urban areas should
have the minimum acceptable numbers of EmOC facilities or at least five
facilities (including at least one comprehensive facility) per 500,000
population (WHO et al., 2010).

Data Requirement(s):

Spatial analysis conducted with the use of GIS
mapping for the distribution of facilities and for estimates of the proportion
of households within two hours of a basic EmOC facility. Alternatively,
estimates can be made of minimum acceptable numbers of EmOC facilities within subnational
areas using lists of the numbers and locations of basic and comprehensive EmOC
facilities. Data on EmOC facilities in subnational areas can be stratified by public,
private, and non-governmental types of facilities.

If targeting and/or linking to inequity, classify the facilities by location (poor/not poor) and disaggregate by location.

This indicator
measures access to EmOC services based on geographic distribution and travel time
to facilities. Simply having sufficient numbers of EmOC facilities is not enough;
their geographic distribution must also be considered. For example, if all comprehensive EmOC
facilities are clustered in urban areas, a large number of women, especially
those living in rural areas, will not be able to access services in a timely
manner. Women’s access to basic and comprehensive EmOC services is vital to
achieving Millennium Development Goals #5. improve maternal health #4. reduce
child mortality.

In settings with rugged
terrain, traveling even relatively short distances may take a very long time
with the journey often made on foot, horseback or by donkey cart. Thus, a companion
indicator for the proportion of households within a given travel time for a
woman to reach a basic or comprehensive EmOC facility is useful. Ideally, all
women should live within two hours of a basic EmOC facility. This time frame
was selected as a maximum limit because hemorrhage, the most rapidly fatal
complication of pregnancy, can kill a mother in two hours. Therefore, in order
to save the maximum number of lives, facilities must be able to treat pregnant
women within two hours. Hemorrhage can be treated at a basic EmOC facility, although
some cases may need to be referred to a comprehensive facility for blood
transfusions. An optimal geographic distribution of facilities would ensure
that all women live within two hours of a basic EmOC facility and within twelve
hours of a comprehensive one (UNFPA, 2004). The creation and dissemination of maps
that show the EmOC status of facilities, the distance of communities from basic
and comprehensive facilities (both in travel time and in relation to road
networks), population dispersion and density and other features that show
inequities in terms of access to care can be effective advocacy and planning
tools.

Issue(s):

While this indicator
measures physical access, it does not address other barriers to access at EmOC
facilities, such as stockouts of necessary drugs, lack of available trained
staff, or inadequate equipment and supplies. This indicator
is best measured by performing spatial analysis with the use of maps or GIS
(which requires the appropriate software and expertise using it). In many developing countries, the terrain is
rough and communications, roads and transportation are poor, making estimates
of the travel time difficult. The alternative estimation of minimum acceptable numbers
of facilities per subnational area (WHO et al., 2010) does not provide
information on actual distances or travel times to the closest facilities.

MEASURE Evaluation Population and Reproductive Health (PRH) is funded by the U.S. Agency for International Development (USAID). The information provided on this Web site is not official U.S. Government information and does not necessarily represent the views of USAID or the U.S. Government.